When is treatment indicated for Scheuermann disease (juvenile kyphosis)?

Updated: Sep 08, 2020
  • Author: Jozef E Nowak, MD; Chief Editor: Stephen Kishner, MD, MHA  more...
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Answer

The treatment of Scheuermann's disease is controversial. [5, 6] Some authors think that the natural history of thoracic Scheuermann's disease is benign and that therefore the condition needs no treatment. Whether orthotics or surgical treatments prevent any of the consequences that may occur is uncertain.

When the kyphosis is relatively severe, recommendations include casting, a spinal brace, or rest and recumbency on a rigid bed. Orthotic management of Scheuermann's disease usually requires 12-24 months of treatment.

Surgery rarely is indicated in patients with Scheuermann's disease. Probably the two most common indications for surgery are spinal pain and unacceptable cosmetic appearance. These criteria are subjective, so it is wise to be cautious in counseling these patients. [7]

In patients with curves greater than 75° and with pain that is unresponsive to nonoperative measures, consider spinal fusion. Spinal fusion consists of an anterior release and fusion, as well as a posterior instrumentation and fusion performed under the same anesthesia on the same day.

Cord decompression is indicated for the rare patients who have neurologic deficits secondary to epidural cysts or increased kyphotic angulation.


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